Salivary Gland Pleomorphic Adenoma Research Articles

Pleomorphic Adenoma of the Palate: Clinicoradiological Case Report

Salivary gland tumors are a relatively rare and morphologically diverse group of lesions. Pleomorphic adenoma is a benign tumor of the salivary gland that consists of a combination of epithelial and mesenchymal elements. The tumor most commonly arises from the parotid (60-70%) or submandibular glands. It develops less frequently in a minor salivary gland, presenting as an intraoral mass dependent on the palate. Pleomorphic adenoma rarely causes bony erosion or destruction. Here, we present a case of benign pleomorphic adenoma of the minor salivary gland originating on the palate causing bony erosion of the alveolar ridge. The clinical, radiological, computed tomographical and histopathological aspects are discussed.

Malignant pleomorphic adenoma of salivary gland with subtype of the malignant component classified as non-specific adenocarcinoma: a clinicopathologic study of 65 cases

To analyze the clinicopathologic features of salivary malignant pleomorphic adenoma (MPA) (the subtype of the malignant component was classified as non-specific adenocarcinoma). The clinical and pathological characteristics of 115 salivary gland tumors histologically diagnosed as MPA were analyzed. In all the 65 MPA cases, there were 58 male and 7 female patients, and the mean age was 57 years (from 23 to 83). Sixty-one tumors were located in major salivary glands, and 4 in minor. Histologically the malignant components of 39 tumors were high-grade, 14 intermediate-grade, and 12 low-grade. Thirty-seven tumors were invasive carcinoma, 13 minimally invasive, and 15 non-invasive. The high-grade tumors had positive correlation with the invasive carcinomas (P < 0.05). The invasive carcinomas had positive correlation with TNM clinical stage (P < 0.05). The invasive carcinoma and the high-grade tumor had correlation with cervical lymph node metastasis (P < 0.05). Non-specific adenocarcinoma are the most common malignant subtype in MPA. The invasive and the high-grade types are more likely to metastasize to cervical lymph node.

Adenome pleomorphe des glandes salivaires accessoires

Objective : Pleomorphic adenoma (PA) is the most common benign neoplasm of the minor salivary glands. Clinical behavior, diagnosis, treatment modalities and evolution of nine cases of pleomorphic adenoma were discussed. Materials and methods : This is a descriptive and retrospective study about 9 cases of pleomorphic adenoma conducted over a period of 20 years (1990 a 2009) at the ENT department of Sousse (Tunisia). Results : There were 5 men and 4 women having a mean age of 40 years. The main site of this adenoma was the hard palate. The others 3 tumors were seen in the nasal cavity, in the parapharyngeal space and in cervical soft tissues. Clinical examination showed a swelling at the level of the interested region. Computed tomography (CT) was made in 5 cases, associated to the magnetic resonance imaging (MRI) in 2 cases. The treatment was based in surgical excision of the tumors. Histologically, the tumor showed features of a benign PA in 8 cases and of malignant PA in 1 case. Two patients had a documented local recurrence. The evolution was good for the first patient after secondary excision of the tumor. The patient presenting a carcinoma ex pleomorphic adenoma developed quickly pulmonary and cerebral metastases. Conclusion : Pleomorphic adenoma of minor salivary gland is generally known to be a slow-growing tumour. They must be evoked before all painless swelling in the upper aerodigestive tract developed under a healthy mucosa. The surgical management is basically total resection of the tumor with a safety margin of 5 mm. Longer follow-up was needed due to the possibility of recurrences and malignancy transformation. Keywords : Pleomorphic adenoma, Minor salivary gland, Imaging.

WT1 expression in salivary gland pleomorphic adenomas: a reliable marker of the neoplastic myoepithelium

Pleomorphic adenoma is a benign salivary gland neoplasm with a diverse morphology. This is considered to be a function of the neoplastic myoepithelium, which shows histological and immunophenotypical variability. Wilms' tumor 1 gene (WT1) protein, involved in bidirectional mesenchymal–epithelial transition, has been detected by reverse transcription PCR in salivary gland tumors showing myoepithelial–epithelial differentiation. The aim of this study was to investigate the immunoreactivity of WT1 in pleomorphic adenomas and to compare the pattern of staining with p63 and calponin, two reliable markers of myoepithelial cells. A total of 31 cases of pleomorphic adenoma were selected. The myoepithelium was classified as myoepithelial-like (juxtatubular and spindled), modified myoepithelium (myxoid, chondroid and plasmacytoid) and transformed myoepithelium (solid epithelioid, squamous and basaloid cribriform). Immunohistochemistry for WT1, p63 and calponin was assessed in each myoepithelial component, as well as in nonneoplastic myoepithelial cells and inner tubular epithelial cells. There was no immunostaining of tubular epithelial cells by any of the markers. In contrast to p63 and calponin, WT1 did not react with normal myoepithelial cells. Cytoplasmic WT1 staining was present in all pleomorphic adenomas, and in 29 cases (94%), >50% of neoplastic myoepithelial cells were highlighted. p63 and calponin stained the myoepithelium in 30 tumors. In comparison, 50% of cells were positive in 21 (68%) and 9 (29%) cases of p63 and calponin, respectively. Staining with WT1 showed less variability across the spectrum of myoepithelial differentiation with the difference most marked in the transformed myoepithelium. WT1 is a sensitive marker of the neoplastic myoepithelial cell in pleomorphic adenomas. The role of this protein in influencing the mesenchymal–epithelial state of cells suggests that WT1 and the myoepithelial cell have an important role in the histogenesis of pleomorphic adenomas.

Increased mucin 1 expression in recurrence and malignant transformation of salivary gland pleomorphic adenoma

Pleomorphic adenoma (PA) is the most common salivary gland tumour with a tendency to recur (RPA) and a risk of malignant transformation. Mucin 1 (MUC-1) plays a role in the progression of many tumours and may be a marker to predict RPA. The aim of this study was to evaluate MUC-1 expression in different phases of the adenoma to carcinoma sequence. Twenty-one cases of PA, 18 cases of RPA, three cases of RPA with focal transformation (TRPA) and 11 cases of carcinoma ex-pleomorphic adenoma (CXPA) were analysed immunohistochemically for MUC1 expression using an antibody to MUC1/DF3. MUC1 reactivity in RPA was stronger than that observed in PA and, in all the different carcinoma groups, MUC-1 expression was significantly higher in carcinoma than in RPA and PA. This study has confirmed that MUC-1 is related to the recurrence of PA and that this molecule is associated with malignant transformation of PA with carcinoma cells overexpressing MUC-1.

Rapidly Growing Chondroid Syringoma of the External Auditory Canal: Report of a Rare Case

Introduction. Chondroid syrinoma of the external auditory canal is an extremely rare benign neoplasm representing the cutaneous counterpart of pleomorphic adenoma of salivary glands. Less than 35 cases have been reported in the international literature. Case Presentation. We report a case of a 34-year-old male in whom a rapidly growing, well-circumscribed tumor arising from the external auditory canal was presented. Otoscopy revealed a smooth, nontender lesion covered by normal skin that almost obstructs the external auditory meatus. MRI was performed to define the extension of the lesion. It confirmed the presence of a 1.5 × 0.8 cm T2 high-signal intensity lesion in the superior and posterior wall of EAC without signs of bone erosion. The patient underwent complete resection of the tumor. The diagnosis was confirmed by histopathologic examination. Conclusion. Although chondroid syringoma is extremely rare, it should always be considered in the differential diagnosis of an aural polyp. Chondroid syringomas are usually asymptomatic, slow-growing, single benign tumors in subcutaneous or intradermal location. In our case, the new information is that this benign tumor could present also as a rapidly growing lesion, arising the suspicion for malignancy.

Pleomorphic adenoma of the upper lip

This case report describes a rare and unusual lesion found in a 33-year-old male, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, large firm mass, about 3 cm in diameter, almost obstructing the nares and characterized by slow growth. Complete excision was performed and the histopathologic analysis showed pleomorphic adenoma. The tumor did not recur. A brief review of the relevant literature is also presented.

Pleomorphic adenoma of the soft palate: Myoepithelial cell predominant

The pleomorphic adenoma is the most common salivary gland tumor. A remarkable morphological diversity can exist from one tumor to the next. We present here a case of pleomorphic adenoma of minor salivary glands of the soft palate which had predominantly myoepithelial cells with minimal stroma, ductal cells, or tubular elements.

Genomic changes in salivary gland pleomorphic adenomas detected by comparative genomic hybridization

The aim of this study was to investigate whether so far unknown chromosomal alterations in pleomorphic adenoma (PA) exist. To this end, tissue samples from 18 patients with parotid gland PA were studied by comparative genomic hybridization (CGH) using Phi-29-DNA-polymerase for DNA amplification. The most common aberrations were losses of chromosomal material of 19p (6/18), 9q, 16p, and 19q (in 3 out of 18 patients each). Additional losses were observed on 4p, 5q, and 17q (2 / 18 each). Gains involved chromosomes 2p, 4p, 6p, 17q, and 21q (2 / 18 each). Losses of 19p have been associated with inactivation of tumor-suppressor genes in carcinomas previously. As a result, pleomorphic adenomas show a considerable diversity of chromosomal gains and losses detected by CGH. The 19p arm, and particularly its 19p13 region, need be further studied to elucidate the potential impact of associated lost tumor suppressor genes on PA development.

Expression of transforming growth factor-β(1) and Ki-67 nuclear antigen in salivary gland mucoepidermoid carcinoma

To investigate the expression and significance of transforming growth factor-β(1) (TGF-β(1)) and Ki-67 nuclear antigen in salivary gland mucoepidermoid carcinoma. The expression of TGF-β(1) and Ki-67 nuclear antigen in 20 cases of salivary gland pleomorphic adenoma and 45 cases of mucoepidermoid carcinoma were detected by the streptavidin-peroxidase immunohistochemical method. Expression of TGF-β(1) (39/45) and Ki-67 nuclear antigen (43/45) in mucoepidermoid carcinoma was significantly higher than in pleomorphic adenoma (P < 0.05). TGF-β(1) expression was significantly higher in moderately/poorly differentiated mucoepidermoid carcinoma (16/16) than that in well differentiated mucoepidermoid carcinoma (23/29) and pleomorphic adenoma (12/20) (P < 0.05), but not different between well differentiated mucoepidermoid carcinoma (6/23) and pleomorphic adenoma (8/12) (P > 0.05). The expression of Ki-67 was increased with the increment of TGF-β(1) expression in mucoepidermoid carcinoma (P < 0.05). The high expression of TGF-β(1) may play an important role in cell differentiation and malignant proliferation of mucoepidermoid carcinoma.

The Increased MUC1 Expression in Recurrence and Malignization of Salivary Gland Pleomorphic Adenoma

The Increased MUC1 Expression in Recurrence and Malignization of Salivary Gland Pleomorphic Adenoma

Extra-major salivary gland pleomorphic adenoma of the head and neck: a 10-year experience and review of the literature

Pleomorphic adenomas, or benign mixed tumors, make up 65% of all salivary gland tumors. They also can be found as solid tumors in other parts of the head and neck region, such as the auditory canal, the eyelids, and the orbital area. In this study, we investigated extra-major salivary gland pleomorphic adenomas of the head and neck region retrospectively at a tertiary care center. Between March 1998 and June 2009, 37 patients underwent primary surgery for extra-major salivary gland pleomorphic adenoma of the head and neck. The duration of symptoms, radiographic findings, operative procedures, and pathologic findings were documented. Of the 37 patients enrolled, 22 were male and 15 were female, with a median age of 57 years. Tumors were found in the soft palate, hard palate, nasopharynx, orbital area, trachea, buccal mucosa, cheek, nasal septum, upper lip, lower eyelid, and external auditory canal. Cellular variant of the pleomorphic adenoma was found in four patients, while the remaining patients presented with the classic variant. No myxoid subgroup was noted in our study. Carcinoma ex pleomorphic adenoma was observed only in one patient for whom radical surgery was performed. Twenty-eight patients (76%) had long-term follow-ups, with the average follow-up period being 4.5 years. Local recurrence was observed in three patients, and they underwent revision surgery during the follow-up period. Our results indicate that extra-major salivary gland pleomorphic adenomas are most commonly found in the soft palate. Wide excision was the treatment of choice, although its efficacy might be compromised with cosmetics and functional structures of the head and neck. Therefore, long-term follow-up of patients is necessary.

Pleomorphic Adenoma of Minor Salivary Gland in a 14 year Old Child

Salivary gland tumours are rare in childhood, and almost all of them occur in parotid gland. Minor salivary gland tumours are even rarer, pleomorphic adenoma being the most frequently found tumour. Only seventeen cases of pleomorphic adenoma arising in the minor salivary gland tumour have been reported in children and adolescents. Pleomorphic adenoma of minor salivary gland represents about 45% of all the tumours of the minor salivary glands. Pleomorphic adenoma is slowly enlarging tumour indistinguishable from adenoid cystic carcinoma clinically, except for pain and ulceration, which is more common in the latter. Carcinoma arising from pleomorphic adenoma has been reported in 3% cases amongst the minor salivary gland tumours. This report presents a case of pleomorphic adenoma of minor salivary gland in a 14year old female patient with a brief review of literature.

The Increased MUC1 Expression in Recurrence and Malignization of Salivary Gland Pleomorphic Adenoma

The Increased MUC1 Expression in Recurrence and Malignization of Salivary Gland Pleomorphic Adenoma

Extracellular Matrix Metalloproteinase Inducer Expression in Salivary Gland Tumors

The purpose of this study was to investigate the expression pattern of extracellular matrix metalloproteinase inducer (EMMPRIN) as well as the correlation between EMMPRIN and microvessel density (MVD) in salivary gland tumors. Extracellular matrix metalloproteinase inducer expression and MVD were examined immunohistochemically on paraffin-embedded tissue specimens from 95 patients with salivary gland tumors, who underwent surgical resection from 1998 to 2006. Reverse transcription-polymerase chain reaction was used to monitor EMMPRIN mRNA expression in frozen samples. Extracellular matrix metalloproteinase inducer expression in mucoepidermoid carcinomas and adenoid cystic carcinomas was significantly higher than in normal salivary gland tissues and pleomorphic adenomas (P < 0.05). The MVD of mucoepidermoid carcinomas and adenoid cystic carcinomas was significantly higher compared with pleomorphic adenomas (P < 0.05). The MVD of the EMMPRIN-positive expression group was significantly higher than the MVD of the EMMPRIN-negative expression group (P < 0.05). Extracellular matrix metalloproteinase inducer mRNA expression in malignant salivary gland tumors was higher than that in pleomorphic adenomas (P < 0.05). This study suggests that EMMPRIN expression is an important feature of malignant salivary gland tumors and can be used as a biologic marker to characterize salivary gland tumors. Extracellular matrix metalloproteinase inducer is also a positive angiogenic factor in salivary gland tumors.

Cutaneous Adnexal Differentiation and Stromal Metaplasia in Palate Pleomorphic Adenomas: A Potential Diagnostic Pitfall That May Be Mistaken for Malignancy

Cutaneous adnexal differentiation is well-recognized in benign mixed tumors occurring in cutaneous sites. The incidence of this histologic finding in salivary gland sites is not known. We sought to describe the incidence of cutaneous adnexal differentiation in benign mixed tumors of the palate, lip, and parotid gland. Benign mixed tumors of the palate (n=30), lip (n=13), and parotid gland (n=37) resected between 1980 and 2009 at a single academic medical institution were reviewed. All hematoxylin and eosin-stained sections containing neoplasm were reviewed by all authors including one dermatopathologist (S.H.O.). After confirming the diagnosis of benign mixed tumor, we evaluated for morphologic evidence of cutaneous adnexal differentiation and metaplastic epithelial and stromal changes. Chart review was conducted to obtain pertinent clinical information. Cutaneous adnexal differentiation was seen in 20% of palate and 39% of lip benign mixed tumors but in no parotid tumors. The most frequent features of cutaneous adnexal differentiation were tricholemmal differentiation (20% of palate and 39% of lip tumors), infundibulocystic structures (17% and 31%), and trichohyalin granules (13% and 31%). Sebaceous differentiation was seen in only one palate tumor. Varying amounts of stromal adipose were seen in 62, 37, and 22% of lip, palate, and parotid tumors. Osseous metaplasia was seen in one tumor from each site. When cutaneous adnexal differentiation occurs in salivary gland pleomorphic adenomas, it can present a diagnostic pitfall that must not be misinterpreted as carcinoma at biopsy, fine needle aspiration, or frozen section.

Pleomorphic Adenoma (Benign Mixed Tumour) of the Minor Salivary Glands of the Upper Lip

Pleomorphic adenoma is the benign tumor of salivary glands, which originates from the myoepithelial cells and intercalated duct cells. This tumor is more common in major salivary glands. This case report describes a rare and unusual lesion in a 55-year-old female, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, submucosal nodule, about 2.0cm in diameter and was characterized by slow growth and rubbery consistency. Complete excision was performed and the histopathological analysis showed an epithelial salivary gland tumor with islands of plasmacytoid cells, duct like structures, in a variable stroma with chondroid, fibrous and myxoid appearance. No recurrence was observed 1year after the surgery.

Pleomorphic adenoma of minor salivary gland with therapeutic misadventure: a rare case report

BackgroundThe benign tumors of nasopharynx are least encountered tumors in otolaryngology, as nasopharynx is considered one of notorious anatomical site for the malignant tumors. Pleomorphic adenoma of the minor salivary gland of nasopharynx and parapharyngeal space is rare. We present a pleomorphic adenoma of minor salivary gland which was mismanaged.Case presentationAn adult male presented with left nostril obstruction for five months. The examination found big mass extending from nasopharynx to oropharynx. On CT scan, this tumor was quite big and extending to the parapharyngeal space. The FNAB found it a carcinoma but it did not respond to radiotherapy. The excision biopsy of tumor revealed it as pleomorphic adenoma. We found only five published reports on this tumor arising from nasopharynx.Discussion and conclusionAlthough, in this case report exact origin of the tumor could not be ascertained as it also appeared to be a parapharyngeal tumor but we kept the possibility of a nasopharyngeal tumor on the basis of clinical features. The pleomorphic adenoma of nasopharynx is rare. It can be misdiagnosed as malignant epithelial tumor on histopathology. The differentiation from its malignant variant is also difficult. A possibility of benign tumor should always be kept in nasopharyngeal growth with no evidence of metastasis, and histopathological diagnosis of growth should be available before any definitive treatment.

Pleomorphic adenoma of the hard palate

Pleomorphic adenoma is the most common benign salivary gland tumor, which has elements of both epithelial and mesenchymal tissues. The tumor most commonly arises in the parotid or submandibular glands. Infrequently, it may arise from the minor salivary glands. We report a case of pleomorphic adenoma of minor salivary gland of palate in an 18-year-old young female patient for which the surgical treatment was rendered and with no evidence of recurrence.

頬部小唾液腺多形腺腫例―手術アプローチを考えて―

Pleomorphic adenoma, as the most common salivary gland tumor, primarily involves major glands, especially the parotid gland. Minor glands involve, mostly the palate, being relatively uncommon in the cheek. The malar region is close to important organs and malignant tumors, making sufficient preoperative examinations important. To date however, few reports have discussed the usefulness of the variety of examinations. We report a case of pleomorphic adenoma of the minor salivary gland originating in the cheek. A 56-year-old man having a minor left-cheek salivary gland tumor found 10 years ago removed en bloc through the oral cavity for cosmetic reasons has experienced no recurrence in the 2 years since. The extracted tumor was 60×40×30 mm and weighed 50 g. We thus strongly recommend computed tomography, magnetic resonance imaging, sialography, facial nerve excitability testing, and cytodiagnosis in evaluating such lesions.